Choice Dynamics in IVF Treatment

Barton Hamilton, Washington University in St. LouisBrian McManus, University of North Carolina at Chapel HillJuan Pantano, Washington University in St. Louis

Public policy towards IVF has focused on mandating insurance coverage of the procedure, which can improve access while also reducing patients’ incentives to opt for aggressive treatment. We specify a model of individual patients’ choices during IVF treatment. We use a novel dataset of individual patient histories at an IVF clinic, serving a mix of insured and uninsured patients. Using data on treatment choices and outcomes, we estimate the stochastic processes that determine patient success across different stages of IVF treatment. These processes, together with specifications of patients’ preferences over children, delaying treatment, and the disutility of payments, yield a well-specified dynamic optimization problem for choices within and across IVF treatments. We estimate the patients’ preference parameters by matching observed treatment histories to those predicted by our model. We use the estimated model to conduct counterfactual experiments that include expansions of insurance coverage and restrictions on patient aggressiveness during treatment.